Obesity is a complex condition influenced by many factors, making it difficult to treat. Th e primary goal is to improve quality of life and reduce the negative impact of obesity, which can shorten life expectancy. Addressing excess weight is crucial to achieving this goal. 

Treatment often involves a multifaceted approach that evolves as we learn more about this chronic condition. Support and guidance throughout the weight-loss journey are essential, addressing both excess weight and the reasons for suboptimal weight loss or weight regain. However, there’s growing concern about weight regain after surgical treatments, with a recent study finding that over a third of patients experienced significant weight regain seven years after their gastric bypass, while over 75% experienced significant weight regain six years after sleeve gastrectomy. 

Success should be measured with careful attention to nutritional deficiencies and by consolidating even small gains, as they can lead to larger, more sustainable ones. A guide to healthy, lasting weight loss includes lifestyle adjustments in diet, exercise and behaviour, supported by medications, if necessary, under the guidance of healthcare professionals. 

When lifestyle changes aren’t sufficient, more impactful measures such as interventional (intragastric balloon, endoscopic sleeve gastroplasty) or surgical procedures (gastric band, sleeve gastrectomy, gastric bypass) may be necessary. Choosing the right procedure can be challenging and is influenced by patient perceptions and financial constraints. 

For those hesitant about surgery, intragastric balloons off er a safe alter- native. Used since the 1980s for BMIs of 27 and over, technological improve- ments now allow safe placement in the stomach for four to 12 months, inducing fullness to reduce food intake. Patient selection is key for a successful outcome, with candidates typically undergoing a thorough evaluation to assess their suitability for the procedure, including medical history, current health status and weight-loss goals. 

Clinical studies have shown that most weight loss achieved with intra- gastric balloons (around 10 to 15% of excess weight) occurs within the first three months after placement and then plateaus. Gastric balloons aren’t a permanent solution for weight loss; they’re a tool to kickstart weight loss and help patients adopt healthier habits. 

Success in weight loss is ultimately measured by the ability to maintain it. Commitment to lasting lifestyle changes, understanding our relationship with food and overcoming addictions are crucial. Seeking instant gratification and grazing often lead to failure in achieving or sustaining a healthy weight, regard- less of treatment. 

Instead, a positive mindset is essential and complements any weight-loss treatment. If you’re feeling unsure and over- whelmed by the abundance of information available, Mr R Camprodon, a specialist surgeon in weight loss, can offer guidance to help you make an informed decision.